AccountId: 011433970860
ContactId: 403467e4-eecb-4e14-b6a6-28f71dc6602e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 446769 ms
Total Talk Time (AGENT): 173767 ms
Total Talk Time (CUSTOMER): 99718 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/403467e4-eecb-4e14-b6a6-28f71dc6602e_20250327T15:00_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, uh, I was calling to get eligibility and benefit information on one of our patients. I'm calling from a facility.
[AGENT][NEUTRAL] OK, so you're needing to get, um, give me just one moment. I'm so sorry. One moment, please.
[CUSTOMER][POSITIVE] That's OK, thank you.
[AGENT][POSITIVE] OK, I'm so sorry. So could you please say that again, our connection I was missing part of what you said and I do, I'm sorry about that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's OK. Uh, I'm calling from a facility and I was needing to get eligibility and benefit information on one of our patients.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so you need eligibility and benefits for one member, is that correct?
[CUSTOMER][NEUTRAL] That, yes.
[AGENT][POSITIVE] Yes ma'am, I can help you with that and who am I speaking with please?
[CUSTOMER][NEUTRAL] Um, [PII]
[AGENT][NEUTRAL] Thank you and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] Uh, is it the one that says policy slash cert number?
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh.
[CUSTOMER][NEUTRAL] Open card OK 02544684.
[AGENT][NEUTRAL] OK thank you one moment while I get the member's information pulled up please.
[AGENT][NEUTRAL] And any information added that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Uh, it's [PII]
[CUSTOMER][NEUTRAL] And date of birth [PII].
[CUSTOMER][NEUTRAL] You OK.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] And there's like
[AGENT][NEUTRAL] OK, so I do see where she is the spouse of the subscriber on this limited benefit plan and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And again this is a limited benefit plan. It is not major medical, so what type of benefit information do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Uh, it's outpatient ambulatory surgical Center.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And [PII], again, I do apologize that I'm gonna have to try and reload.
[CUSTOMER][NEUTRAL] Literally
[CUSTOMER][NEUTRAL] I would say the Huddle.
[CUSTOMER][NEUTRAL] In
[CUSTOMER][NEUTRAL] Get to this point
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] OK. So on this policy, on this limited benefit policy, the accident and uh sickness benefit for surgical
[AGENT][NEUTRAL] The facility is $500.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Per day and it's a maximum of one day per calendar year per covered person.
[CUSTOMER][NEUTRAL] Very
[CUSTOMER][NEUTRAL] So they would owe $500.
[AGENT][POSITIVE] That is the benefit that this plan pays.
[AGENT][NEUTRAL] That's the maximum, right. Yes, because this is not major medical insurance. It is a limited benefit plan that does pay specific amounts for certain services.
[CUSTOMER][NEUTRAL] Oh, so anything, oh, OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got you. OK, so if, so say they had like their procedure was 1000, you guys would pay 500, they would pay 500.
[AGENT][NEUTRAL] Well, I can't, I can't guarantee payment, obviously, as I stated, [PII], but that is the benefit on this policy for an approved.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Procedure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And then once the claim.
[CUSTOMER][NEUTRAL] Alright, and then can I just have.
[AGENT][NEUTRAL] Oh, I'm sorry. I'm gonna give you a reference number if, if you all do file a claim, once it has been processed, we do have a portal.
[CUSTOMER][NEUTRAL] It's OK. Yes.
[AGENT][NEUTRAL] In which you should be able to check claim status and adding the website for our portal is secured.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] All right. Well, is there anything else that I can help you with at the moment?
[CUSTOMER][NEUTRAL] Uh, no, I think that's it.
[AGENT][POSITIVE] OK, well thank you again for your patience and me having to restart some of my screens. So if that is all I can help you with, thank you for calling APL and I hope you have a very nice day.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] No, that's OK.
[CUSTOMER][NEUTRAL] Uh, could I have a reference number please?
[AGENT][NEUTRAL] Sure, my name and today's date.
[CUSTOMER][NEUTRAL] And what was your first name again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] All right, thank you so much have a good day.
[AGENT][POSITIVE] OK. Well, you are certainly very welcome, yes, ma'am, and thank you again for calling APL and I hope you have a great day too.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes, ma'am. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm bye bye.